Pivotal Response Treatment: What Is It And How Does It Work?

Pivotal Response Treatment (PRT) is an intervention for autism that is derived from Applied Behavior Analysis (ABA) principles.

PRT focuses on individual behaviors, one at a time, and uses positive reinforcement to help improve social, behavioral, and communication skills in children with autism.

Pivotal Response Treatment was developed by Dr. Robert L. Koegel, Dr. Lynn Kern Koegel, and Dr. Laura Shreibman, at the University of California, Santa Barbara.

PRT was previously called the Natural Language Paradigm, which has been in development since the 1970s. Like ABA therapy, PRT is a behavioral intervention model that uses reinforcement to modify behavior and to increase a child’s willingness to participate in learning new skills.

PRT is used to teach language skills, to decrease disruptive behaviors, and to increase academic, social, and communication skills.

PRT is child-directed (that is, the child makes choices in determining what activities and objects will be used in the therapy) and uses reinforcers to reward behavior.

PRT advocates believe that motivation and the ability to respond to multiple cues are 2 pivotal behavioral skills and that developing these 2 skills will result in a larger, overall improvement in behavior.

Motivation and the initiation of activities are the major areas that PRT focuses on.

The theory behind PRT holds that an improvement in these areas will mean improvement in other, non-targeted areas of behavior, such as self-management, communication, turn-taking, and language.

In order to develop these skills, PRT is often used in a play setting.

Therapists start with single-step play then move on to model more complex ideas.

Therapists provide clear instructions to the child, offer a choice of stimuli, and direct reinforcement (e. g. if a child decides to ask for a particular toy and attempts to request that toy, he or she receives that toy, and not a different, unrelated object, and receives it immediately).

In effective PRT sessions, previously mastered tasks should be interspersed in the therapy in order to maintain them, and rewards should be immediate and contingent upon response attempts.

Naturally occurring opportunities to teach and their consequences are used in PRT, making it a loosely-structured therapy and one that parents can implement.